Firearm Storage Behaviors — Behavioral Risk Factor Surveillance System, Eight States, 2021–2022

Secure firearm storage might help reduce access by children and other unauthorized users and the related risk for injury or death. Information about state-specific prevalence of firearm storage practices can be used to develop secure storage messages and programs; however, such information is often unavailable. Data from the Behavioral Risk Factor Surveillance System, by respondent characteristics, were used to estimate prevalence of keeping firearms in or around the home and related storage practices for eight states that administered the firearm safety module in 2021 or 2022. Overall, 18.4% (California) to 50.6% (Alaska) of respondents reported that a firearm was kept in or around their home. Among those with a firearm in or around the home, 19.5% (Minnesota) to 43.8% (North Carolina) reported that a firearm was stored loaded. Across all eight states, approximately one half of those with a loaded firearm stored at least one loaded firearm unlocked. Among respondents with a child and a loaded firearm in the home, 25.2% (Ohio) to 41.4% (Alaska) reported that a loaded firearm was stored unlocked. Variability in firearm storage practices highlights the importance of local data and suggests opportunities to tailor prevention efforts to specific population groups to reduce risk for firearm handling by children without adult supervision, and other unauthorized persons.


Introduction
The firearm homicide rate in the United States declined slightly from 2021 (6.3 per 100,000 persons) to 2022 (5.9); however, the rate remained 34% higher than it was during 2019 (4.4) (1).The firearm suicide rate in 2022 (8.1 per 100,000 persons) increased since 2019, resulting in the highest rate since 1968 (the earliest year of data in CDC WONDER, an online public health database) (2).The presence of a firearm in the home has been associated with an increased risk for firearm homicide and suicide among household members, irrespective of their personal firearm ownership status (3).A risk for unintentional firearm injuries among youths also exists (4).These risks might be reduced by secure storage practices, including keeping a firearm unloaded and locked, especially among youths (4)(5)(6).Data on state-and population-specific storage practices are important for guiding the development and evaluation of tailored prevention activities.Data on adults' reports of firearm storage practices were used to estimate the prevalence of firearms in or around the home and to examine related storage practices by sociodemographic characteristics.

Data Source
The Behavioral Risk Factor Surveillance System (BRFSS) is an annual, state-based, random-digit-dialed landline and mobile telephone survey that collects data on health-related behavioral risk factors and sociodemographic characteristics from noninstitutionalized adults aged ≥18 years in all 50 states, the District of Columbia, and participating territories.BRFSS includes core questions for all states, questions added by individual states, and optional modules, including the firearm safety module.*During 2021 and 2022, eight states administered the firearm safety module.†

Statistical Methods
Weighted percentages and corresponding 95% CIs were estimated by state and stratified by whether the respondent indicated the presence of a child or adolescent aged ≤17 years living in the home and by sociodemographic characteristics, including sex, age group (18-24, 25-34, 35-64, and ≥65 years), and race and * The prologue for the module instructs respondents to include firearms that are "kept in a garage, outdoor storage area, or motor vehicle."The first question further instructs respondents to not include BB guns or guns that cannot fire.
Respondents completing this module are asked, "Are any firearms now kept in or around your home?" Households of respondents who answer "Yes" are categorized as a household with a firearm, and respondents are then asked, "Are any of these firearms now loaded?"Respondents who report loaded firearms are asked, "Are any of these loaded firearms also unlocked?"The third question includes an explanation for unlocked: "By unlocked, we mean you do not need a key or a combination or a hand/fingerprint to get the gun or to fire it.Don't count the safety as a lock."Respondents who answer "No," "Don't know," "Not sure," or "Refused" at any point advance to the next module.† Six states (Alaska, California, New Mexico, North Carolina, Ohio, and Oklahoma) administered the firearm safety module in 2021.In 2022, five states (California, Minnesota, Nevada, New Mexico, and Ohio) administered the firearm safety module.The most recent year of data is reported for each state.ethnicity (non-Hispanic Black or African American [Black], non-Hispanic White [White], non-Hispanic other [other], and Hispanic or Latino [Hispanic]).All respondents were included in the analysis, including those responding, "Don't know," "Not sure," or "Refused" to any item in the firearm safety module.All analyses were conducted using SAS (version 9.4; SAS Institute) to account for survey design and complex weighting procedures.This activity was reviewed by CDC, deemed not research, and conducted consistent with applicable federal law and CDC policy.§

Response Rate and Prevalence of Having a Firearm in or Around the Home
The mean combined response rate for BRFSS was 44.6% in 2021 and 45.9% in 2022.The percentage of respondents who declined to answer the first question of the module (i.e., whether any firearms are kept in or around the home) ranged from 3.6% (New Mexico) to 12.0% (Oklahoma).Among all respondents, the percentage of adults reporting a firearm kept in or around their home ranged from 18.4% (California) to 50.6% (Alaska) (Table 1).

Characteristics of Respondents with a Firearm in or Around the Home
The presence of a firearm varied by sociodemographic characteristics.For example, in all participating states other than §    * Adults who reported a current loaded firearm in or around their home and locked status.
† Six states (Alaska, California, New Mexico, North Carolina, Ohio, and Oklahoma) administered the firearm safety module in 2021.In 2022, five states (California, Minnesota, Nevada, New Mexico, and Ohio) administered the firearm safety module.The most recent year of data is reported for each state.§ Estimates are weighted to each state's adult population.Because denominators vary among each sociodemographic characteristic, the prevalence estimates represent the behavior among a specific group.In addition, estimates by race and ethnicity are not reported because of data suppression requirements.¶ Respondents who reported "Don't Know, " "Not Sure, " or "Refused" to questions on locked status or age were suppressed because the sample size is <30, or the absolute value of the CI is ≥0.30, or the relative CI width is >130% of the proportion.** Dashes indicate data are not reported because the sample size is <30, or the absolute value of the CI is ≥0.30, or the relative CI width is >130% of the proportion.
firearm was stored loaded.Across states and sociodemographic groups, the household presence and storage of firearms varied, highlighting the importance of focused and culturally tailored efforts to enhance secure storage.For example, in at least 25% of homes in which the respondent reported having a child or adolescent aged ≤17 years in the home and a loaded firearm, at least one loaded firearm was stored unlocked.Previous research has demonstrated that most fatal unintentional firearm deaths among children and adolescents aged 1-17 years occur in a house or apartment, and that the firearms used were often stored loaded and unlocked and were discharged during play or when showing the firearm to someone else (7).These findings underscore the importance of discussing secure firearm storage practices with parents and caregivers, including supporting them in asking about the presence of unsecured firearms in other homes where their children visit and play, such as the homes of older family members.
These findings suggest an opportunity to examine factors associated with firearm storage patterns to improve secure storage messages and initiatives.Few studies have examined the effectiveness of prevention efforts in increasing secure storage, and most of those that do focus on health care providers during health care visits (6).
However, a national survey of firearm owners found fewer than one in five (19%) selected physicians as "good" or "excellent" messengers to teach gun owners about secure storage practices, compared with approximately three quarters (77%) who selected law enforcement (8).In addition, few studies explore barriers and facilitators associated with secure storage.One national survey of firearm owners found that concern about home defense was selected by 43% of respondents as a factor influencing gun storage (8).Researchers have called for collaboration with diverse partners, including firearm owners, community members, and parents, to better understand the barriers and facilitators for focused and effective secure storage interventions (9).
Future research could evaluate community-and society-level approaches for increasing secure firearm storage and reducing firearm injuries.Providing secure storage devices (e.g., cable locks, trigger locks, and lock boxes) has been associated with improvement in firearm storage practices (6).Another approach implemented in some states is child access prevention negligent storage (CAP-NS) laws, which impose penalties on adults who allow children unsupervised access to unlocked firearms (10).Although reviews concluded that CAP-NS laws are associated with decreases in fatal and nonfatal firearm injuries in children (5), 45 C.F.R. part 46.102(I)(2), 21 C.F.R. part 56; 42 U.S.C.Sect.241 (d); 5 U.S.C.Sect.552a; 44 U.S.C.Sect.3501 et seq.